Mr. Mason began his presentation by discussing how hospitals and ASCs are responding to the pressures of healthcare reform and provider consolidation. He also differentiated two terms that are often used interchangeably: physician integration and physician alignment.
“Integration is really bringing small practices together into a large practice. There is a lot of that going on right now. Healthcare reform has everyone scared, [unsure] what the effects will be. A lot of physicians are running under the umbrella of the hospital or health system,” said Mr. Mason.
“Physician alignment — this is the healthcare entity’s strategy to gain the support and loyalty of the physician customer to get the physician to utilize the services of the healthcare entity in the treatment of their patient population.” He said physician customer classification can be broken down to three categories: constant, loyal users; intermittent, semi-loyal users; or those who never use the ASC.
Medical practices are quickly consulting, as 55 percent of all physicians now work in large consolidated practices that are health system-based, hospital-based or physician-governed. “The key question to ask is, ‘What impact does the consolidation of the ASC medical staff membership have upon its utilization?'” said Mr. Mason.
Data analytics is what will separate the winners from the losers in healthcare, according to Mr. Mason. Those who can gather, analyze and utilize data appropriately will be much stronger competitors. “You have to know a lot about your business to determine where you need to go tactically and strategically,” he said.
Some analytics to determine an ASC’s strategy in its physician market include: city and county populations; employer analysis; competitive analysis (with local hospitals, ASCs, diagnostic centers, etc.); hospital or employer extended structures (such as PHOs, IPAs, MSOs, etc.); hospital leadership team or management service companies; and medical staff make up.
Analytics not only play a role in determining the ASC’s strategy, but will also determine how providers fare in value-based contracts with insurers. Data is more accessible due to electronic medical records, greater in volume due to automation and more current or even real-time, according to Mr. Mason.
This is especially critical as payors roll out new programs and initiatives to pay based on measurable clinical outcomes criteria. “After four or five years experience with that, I can tell you that we have seen insurers get tougher over the years on those quality metrics and make them more of a stretch goal,” said Mr. Mason.
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